High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT

Borgen, Tove Tveitan; Bjørnerem, Åshild; Solberg, Lene Bergendal; Andreasen, Camilla; Brunborg, Cathrine; Stenbro, May-Britt; Hübschle, Lars Michael; Froholdt, Anne; Figved, Wender; Apalset, Ellen M; Gjertsen, Jan‐Erik; Basso, Trude; Lund, Ida Katrine; Hansen, Ann Kristin; Stutzer, Jens-Meinhard; Dahl, Cecilie; Omsland, Tone Kristin; Nordsletten, Lars; Frihagen, Frede; Eriksen, Erik Fink

doi:10.1016/j.bone.2019.02.008

Cited by 17 publications

(22 citation statements)

References 29 publications

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“…The objectives of NoFRACT are to investigate the effect on the rate of subsequent fractures of introducing a standardized intervention program consisting of an FLS model of care for identification, assessment, and treatment of osteoporosis in patients with fragility fractures. Eligible for the intervention were women and men aged 50 years or older with any recently diagnosed fragility fracture, except fractures in fingers, toes, and head …”

Section: Methodsmentioning

confidence: 99%

“…Patients were also categorized by presence of at least one SQ3 fracture (yes versus no) as a measure of severe deteriorated microarchitecture in trabecular bone. The interobserver agreement of SQ1–SQ3 fractures between two experienced clinicians has shown a κ of 0.84 (95% confidence interval, 0.70 to 0.98) …”

Section: Methodsmentioning

confidence: 99%

“…Eligible for the intervention were women and men aged 50 years or older with any recently diagnosed fragility fracture, except fractures in fingers, toes, and head. (9,10) This cross-sectional substudy (ClinicalTrials.gov, NCT02608801) of NoFRACT (ClinicalTrials.gov, NCT02536898) included patients at the University Hospital of North Norway, Tromsø, from October 1, 2015, to December 31, 2017, and at the Drammen Hospital from January 1, 2016, to December 31, 2017. (10) During this period, 2682 (>90%) patients above 50 years of age coming to the hospitals with a fragility fracture were identified and offered fracture risk assessment.…”

Section: Study Subjectsmentioning

confidence: 99%

“…(9,10) This cross-sectional substudy (ClinicalTrials.gov, NCT02608801) of NoFRACT (ClinicalTrials.gov, NCT02536898) included patients at the University Hospital of North Norway, Tromsø, from October 1, 2015, to December 31, 2017, and at the Drammen Hospital from January 1, 2016, to December 31, 2017. (10) During this period, 2682 (>90%) patients above 50 years of age coming to the hospitals with a fragility fracture were identified and offered fracture risk assessment. In most of the elderly inpatients with fractures of the hip, vertebrae, with two or more fragility fractures, or 10-year probability of major osteoporotic fracture ≥20% calculated using the Fracture Risk Assessment Tool (FRAX), the treatment decision was assessed without a dual-energy X-ray absorptiometry (DXA) scan (n = 1235).…”

Section: Study Subjectsmentioning

confidence: 99%

“…(13) Images of the lateral thoracolumbar spine (T 4 -L 4 ) were obtained and VFA of the fracture severity was performed using the semiquantitative (SQ) vertebral deformity scoring method by Genant. (10,14) An SQ0 (<20% height loss) was considered as a nonfractured vertebra, SQ1 (20% to 25% height loss) as a mild fracture, SQ2 (25% to 40% height loss) as a moderate fracture, and SQ3 (≥40% height loss) as a severe fracture. Presence of one or more SQ1, SQ2, or SQ3 fractures was termed SQ1-SQ3 fracture and presence of one or more SQ2 or SQ3 fractures was termed SQ2-SQ3 fracture.…”

Section: Variablesmentioning

confidence: 99%

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Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Borgen

Bjørnerem

Solberg

et al. 2019

Journal of Bone and Mineral Research

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The location of osteoporotic fragility fractures adds crucial information to post‐fracture risk estimation. Triaging patients according to fracture site for secondary fracture prevention can therefore be of interest to prioritize patients considering the high imminent fracture risk. The objectives of this cross‐sectional study were therefore to explore potential differences between central (vertebral, hip, proximal humerus, pelvis) and peripheral (forearm, ankle, other) fractures. This substudy of the Norwegian Capture the Fracture Initiative (NoFRACT) included 495 women and 119 men ≥50 years with fragility fractures. They had bone mineral density (BMD) of the femoral neck, total hip, and lumbar spine assessed using dual‐energy X‐ray absorptiometry (DXA), trabecular bone score (TBS) calculated, concomitantly vertebral fracture assessment (VFA) with semiquantitative grading of vertebral fractures (SQ1–SQ3), and a questionnaire concerning risk factors for fractures was answered. Patients with central fractures exhibited lower BMD of the femoral neck (765 versus 827 mg/cm2), total hip (800 versus 876 mg/cm2), and lumbar spine (1024 versus 1062 mg/cm2); lower mean TBS (1.24 versus 1.28); and a higher proportion of SQ1‐SQ3 fractures (52.0% versus 27.7%), SQ2–SQ3 fractures (36.8% versus 13.4%), and SQ3 fractures (21.5% versus 2.2%) than patients with peripheral fractures (all p < 0.05). All analyses were adjusted for sex, age, and body mass index (BMI); and the analyses of TBS and SQ1–SQ3 fracture prevalence was additionally adjusted for BMD). In conclusion, patients with central fragility fractures revealed lower femoral neck BMD, lower TBS, and higher prevalence of vertebral fractures on VFA than the patients with peripheral fractures. This suggests that patients with central fragility fractures exhibit more severe deterioration of bone structure, translating into a higher risk of subsequent fragility fractures and therefore they should get the highest priority in secondary fracture prevention, although attention to peripheral fractures should still not be diminished. © 2019 American Society for Bone and Mineral Research. © 2019 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Study Subjectsmentioning

confidence: 99%

Section: Study Subjectsmentioning

confidence: 99%

Section: Variablesmentioning

confidence: 99%

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Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Borgen

Bjørnerem

Solberg

et al. 2019

Journal of Bone and Mineral Research

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Target Values and Daytime Variation of Bone Turnover Markers in Monitoring Osteoporosis Treatment After Fractures

et al. 2022

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The serum bone turnover markers (BTM) procollagen type 1 N‐terminal propeptide (P1NP) and C‐terminal cross‐linking telopeptide of type 1 collagen (CTX) are recommended for monitoring adherence and response of antiresorptive drugs (ARD). BTM are elevated about 1 year after fracture and therefore BTM target values are most convenient in ARD treatment follow‐up of fracture patients. In this prospective cohort study, we explored the cut‐off values of P1NP and CTX showing the best discriminating ability with respect to adherence and treatment effects, reflected in bone mineral density (BMD) changes. Furthermore, we explored the ability of BTM to predict subsequent fractures and BTM variation during daytime in patients using ARD or not. After a fragility fracture, 228 consenting patients (82.2% women) were evaluated for ARD indication and followed for a mean of 4.6 years (SD 0.5 years). BMD was measured at baseline and after 2 years. Serum BTM were measured after 1 or 2 years. The largest area under the curve (AUC) for discrimination of patients taking ARD or not was shown for P1NP <30 μg/L and CTX <0.25 μg/L. AUC for discrimination of patients with >2% gain in BMD (lumbar spine and total hip) was largest at cut‐off values for P1NP <30 μg/L and CTX <0.25 μg/L. Higher P1NP was associated with increased fracture risk in patients using ARD (hazard ratio [HR]logP1NP = 15.0; 95% confidence interval [CI] 2.7–83.3), p = 0.002. P1NP and CTX were stable during daytime, except in those patients not taking ARD, where CTX decreased by 21% per hour during daytime. In conclusion, P1NP <30 μg/L and CTX <0.25 μg/L yield the best discrimination between patients taking and not taking ARD and the best prediction of BMD gains after 2 years. Furthermore, higher P1NP is associated with increased fracture risk in patients on ARD. BTM can be measured at any time during the day in patients on ARD. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

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Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

et al. 2019

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Determinants of trabecular bone score (TBS) and vertebral fractures assessed semiquantitatively (SQ1-SQ3) were studied in 496 women with fragility fractures. TBS was associated with age, parental hip fracture, alcohol intake and BMD, not SQ1-SQ3 fractures. SQ1-SQ3 fractures were associated with age, prior fractures, and lumbar spine BMD, but not TBS. Introduction Trabecular bone score (TBS) and vertebral fractures assessed by semiquantitative method (SQ1-SQ3) seem to reflect different aspects of bone strength. We therefore sought to explore the determinants of and the associations between TBS and SQ1-SQ3 fractures. Methods This cross-sectional sub-study of the Norwegian Capture the Fracture Initiative included 496 women aged ≥ 50 years with fragility fractures. All responded to a questionnaire about risk factors for fracture, had bone mineral density (BMD) of femoral neck and/or lumbar spine assessed, TBS calculated, and 423 had SQ1-SQ3 fracture assessed. Results Mean (SD) age was 65.6 years (8.6), mean TBS 1.27 (0.10), and 33.3% exhibited SQ1-SQ3 fractures. In multiple variable analysis, higher age (β per SD = − 0.26, 95% CI: − 0.36,− 0.15), parental hip fracture (β = − 0.29, 95% CI: − 0.54,− 0.05), and daily alcohol intake (β = − 0.43, 95% CI − 0.79, − 0.08) were associated with lower TBS. Higher BMD of femoral neck (β per SD = 0.34, 95% CI 0.25-0.43) and lumbar spine (β per SD = 0.40, 95% CI 0.31-0.48) were associated with higher TBS. In multivariable logistic regression analyses, age (OR per SD = 1.94, 95% CI 1.51-2.46) and prior fragility fractures (OR = 1.71, 95% CI 1.09-2.71) were positively associated with SQ1-SQ3 fractures, while lumbar spine BMD (OR per SD = 0.75 95% CI 0.60-Osteoporosis International (2020) 31:505-514 https://doi.# The Author(s) 2019 0.95) was negatively associated with SQ1-SQ3 fractures. No association between TBS and SQ1-SQ3 fractures was found. Conclusion Since TBS and SQ1-SQ3 fractures were not associated, they may act as independent risk factors, justifying the use of both in post-fracture risk assessment.

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High prevalence of vertebral fractures and low trabecular bone score in patients with fragility fractures: A cross-sectional sub-study of NoFRACT

Cited by 17 publications

References 29 publications

Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Post-fracture Risk Assessment: Target the Centrally Sited Fractures First! A Substudy of NoFRACT

Target Values and Daytime Variation of Bone Turnover Markers in Monitoring Osteoporosis Treatment After Fractures

Determinants of trabecular bone score and prevalent vertebral fractures in women with fragility fractures: a cross-sectional sub-study of NoFRACT

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